13 February 2013
Prevalence and incidence of anal squamous intraepithelial lesions (ASIL), an anal cancer precursor, remained high in a study of 76 French men who have sex with men (MSM) in the 2 years after they started antiretroviral therapy (ART).
Human papillomavirus (HPV) infection, which can lead to anal cancer, is highly prevalent in HIV-positive and negative MSM. To assess the impact of current combination ART on rates of ASIL, French Valparaiso Study investigators conducted this analysis of 94 HIV-positive antiretroviral-naive MSM enrolled in a longitudinal study from the time they began ART. Men were assessed by anal cytology, histology, and anal HPV DNA testing before they started ART and 12 and 24 months later.
Seventy-six men completed at least two study visits. Their median age was 39.4 years. Median pretreatment CD4 count stood at 301 cells/μL (interquartile range 242 to 339) and at 545 cells/μL at month 24. After 24 months of treatment, 93% of men had a viral load below 50 copies/mL.
Forty-five of 76 men (59%) had an abnormal cytologic result at their initial visit, including 27 (36%) with low-grade squamous intraepithelial lesion (LSIL) and 7 (9%) with high-grade squamous intraepithelial lesion (HSIL).
After 24 months of follow-up, 36 of 69 men (52%) had cytologic abnormalities, with LSIL in 23 (33%) and HSIL in 6 (9%). At that point anal lesions had regressed in severity in 44% of men, while 37% of men had new lesions.
“Our results show a high prevalence and incidence of ASIL in HIV-infected MSM despite immune restoration under cART,” the authors conclude. They believe their findings “emphasize that HIV-positive MSM although receiving effective cART remain at high risk of anal squamous intra-epithelial lesions.”
Source: Christophe Piketty, Béatrice Cochand-Priollet, Emilie Lanoy, Ali Si-Mohamed, Selma Trabelsi, Roland Tubiana, Pierre-Marie Girard, Laurence Weiss, Dominique Costagliola, the Valparaiso Study Group. Lack of regression of anal squamous intraepithelial lesions despite immune restoration under cART. AIDS. 2013; 27: 401-406.
For the study abstract
(Downloading the complete article requires a subscription to AIDS or an online payment; the abstract is free.)
For a review of ASIL management